It’s not just the majority of American voters who are itching from the rash of regulations, taxes and government bureaucracy that has stemmed from Obamacare. Small physician groups aren’t ecstatic with the White House’s latest effort to cajole them into swallowing some bitter pills regarding their day-to-day operations.
This week, several Obama administration officials, including a former member of the National Economic Council, published an article in the Annals of Internal Medicine that urged doctors to “embrace rather than resist change” coming from the new health reform law, which passed in March. These changes include the likely demise of many small physician practices as part of “vertical organization” approaches that would promote more hospitals and large-group practices.
“Physicians who embrace these changes and opportunities are likely to deliver the greatest benefits to their patients, the health system, and themselves,” according to the article, which was written by Nancy-Ann DeParle, Dr. Ezekiel Emmanuel and Dr. Robert Kocher.
But doctors are not buying the Obamacare agenda. Robert Lowes, writing for Medscape Medical News, reported that leaders of several physician groups, including the American College of Physicians, believe small practices should still be a viable delivery method in America’s health care system.
Health policy expert Robert Moffit detailed in a new Web Memo that regulation in Obamacare regarding Medicare payments irrevocably changes the doctor-patient relationship, undercuts physicians’ freedom to remain in smaller private practices, and threatens the continuation of fee-for-service medicine.
Not only will doctors likely be “coerced into standardizing patient care,” Moffit said they’ll also face pressure to participate in an Accountable Care Organization (ACO), a voluntary grouping of health care providers that agree to be accountable for the overall care of Medicare fee-for-service patients they are assigned to.
“In other words, the ACO will provide the bulk of [Medicare] beneficiaries’ primary care services…While consortia of health care providers (including university hospitals and large clinics) have experimented with the concept, ACOs are still a work in progress.”
Health officials in the Medscape article expressed concern that such regulation would prompt more doctors in small-group practices to leave medicine altogether. “If a physician’s only choice is to join a large corporation, we’re going down the wrong path,” former Heritage visiting fellow Dennis Smith said in the article. “We have the greatest health care system in the world because physicians have been independent.”
Approximately 32 percent of American doctors practiced in solo or two-physician offices in 2008, while 15 percent practiced in group offices of three to five physicians, according to a recent physician survey by the Center for Studying Health System Change
